The value of the electrocardiogram in localizing the site of occlusion in patients with ST elevation myocardial infarction

Purpose: In ST elevation myocardial infarction, the site of occlusion is related to the extension of the myocardial necrosis and the prognosis. There have been several studies that attempted to correlate ST elevation or resiprocal ST depression results with the site of occlusion. However the degree of sucsess of these studies varied. In our study, we investigated the value of ST elevation area, a new parameter calculated by using computer program, to identify the culprit lession localization in patients with ST elevation myocardial infarction.Material and methods: Two hundred fifty one consecutive patients [One hundred forty seven patients (125 male, 22 female and mean age 55,3±10,3 years) with acute anterior myocardial infarction and one hundred four patients (89 male, 15 female and mean age 54,6±10,1) with acute inferior myocardial infarction] whom admitted less than sixth hour of chest pain enrolled the study. All patients history and physical examination were recorded. Coronary angiography and transthorasic echocardiyography were performed. The patients with acute anterior myocardial infarction divided to `Proximal LAD? and `Distal LAD? group as the angiographic lession location in left anterior descending artery before and after first septal branch, respectively. The patients with acute inferior myocardial infarction divided to RCA (right coronary artery) and Cx (circumflex artery) group as the angiographic culprit artery. Acute inferior myocardial infarction patients also divided to `Proximal RCA? and `Distal RCA? group as the angiographic lession location before and after the first major right ventriculer branch. Before reperfusion theraphy the electrocardiogram that shows the maximal ST deviation taken and scanned. ST elevation area was measured manually by Trace V 1.5 program. ST elevation and ST elevation area?s sucsess to predict angiographic lession localization compared by SPSS 15.0 and MedCalc program.Results: We observed that V1 ST elevation area was superior to V1 ST elevation to predict the proximal occlusion of left anterior descending artery (p=0.016). ROC curve analysis showed that when 15 mm² was accepted as a cut of value for predict the proximal occlusion of left anterior descending artery, the sensitvity and the specifity were 50% and 87.4%, respectively. In patients with Rentrop 0-1 collateral circulation and TIMI 0-1 flow, the sucsess of V1 ST elevation area to predict the proximal left anterior descending artery occlusion was better than V1 ST elevation (p=0.001). Left ventricular ejection fraction was more reduced in Proksimal LAD group (p=0.025). Family history was found an independent predictor for proximal left anterior descending artery occlusion (p<0.001).There was no difference between ST elevation and ST elevation area in acute inferior myocardial infarction for predicting culprit artery and proximal right coronary artery.Conclusion: As a result, the new parameter V1 ST elevation area is a safe parameter in acute anterior myocardial infarction for predicting proximal left anterior descending artery occlusion. In order to, software programs that can automatically calculate ST elevation area of electrocardiography divice is needed to use this method.